Late Fix Prevents Bug From Causing Major Problem For NJ Medicaid Applicants

Federal, state sites can't communicate but data salvaged for new enrollees

A technical glitch has stymied more than 25,000 New Jersey residents from applying for Medicaid, but state and federal officials were well on the way to resolving the problem yesterday.

Those affected had applied for health coverage through the new federal insurance marketplace -- healthcare.gov -- and learned that they were eligible for Medicaid. While the federal website was supposed to transmit applicant information to the New Jersey FamilyCare program, the data was incorrectly formatted and could not be read by the state site.

When the communication problem was discovered in mid-December, there was some concern that it would delay health coverage for these applicants, who were eligible for insurance under the Affordable Care Act starting January 1.

But federal officials were able to provide the requisite data to state officials by Monday, allowing them to begin processing the applications. The New Jerseyans' health coverage will be made retroactive to January 1.

The glitch didn’t affect most new Medicaid applicants, since they are applying directly to the state program, with the help of county human services offices, healthcare providers, and other organizations.

This particular problem with the federal site is not part of the technical issues that made healthcare.gov inaccessible throughout October and November. However, the delays caused by the earlier problems may have prevented federal officials from learning about this glitch sooner.

State officials only found out about the incompatibility on December 16, when federal officials first provided the files. Since then, state and federal officials have been communicating daily, and the federal Centers for Medicare and Medicaid Services has now provided files that the state can work with, according to Nicole Brossoie, spokeswoman for the state Department of Human Services.

“It’s an ongoing collaboration with CMS” to obtain the necessary information to complete the applications, Brossoie wrote in an email.

All applications submitted before January that are still being processed, as well as new applications filed this month will be made retroactive to January 1.

Opting to Increase Eligibility

Under the 2010 Affordable Care Act, Medicaid will cover healthcare costs for single residents with household incomes up to 138 percent of the poverty line, which currently amounts to $15,856 for a single person. A U.S. Supreme Court decision left it up to each state to decide if it would expand Medicaid eligibility, which Gov. Chris Christie opted to do. Previously, a single, employable adult was only eligible for Medicaid in New Jersey if his or her income was below $2,520 per year.

The ACA provides that the federal government will pay for 100 percent of the costs of the newly eligible residents through 2016. The federal share will fall to 90 percent of costs by 2020, with the state picking up the remaining 10 percent.

It’s too early to tell how many residents have newly enrolled in FamilyCare. A Rutgers Center for State Health Policy study estimated that 234,000 new residents would sign up for the system. Of those, 104,000 would be newly eligible, while the other 130,000 were already eligible but would sign up due to increased attention on the program.

CMS spokeswoman Emma Sandoe wrote in an email that most new Medicaid applicants weren’t affected by the delay.

“This issue impacts a small fraction of the Americans who will have access to healthcare through Medicaid,” she wrote.

Federal officials expect everyone who has been affected by the delay to be contacted by the end of this week.

New Jersey Policy Perspective Senior Analyst Raymond J. Castro said the New Jersey FamilyCare website, which was renovated this year, has been working smoothly. He added that the delay, which was caused by problems with the federal site, has been the only problem with the eligibility expansion.

However, Castro added that it remains to be seen whether the state is on target to reach its Medicaid expansion goals. He said a clearer picture would emerge in February, when the January enrollment statistics become available.

Castro added that it’s important to fix any glitches that prevent communication between the marketplace and FamilyCare websites. This will become increasingly crucial as residents move between the two different insurance systems as their income fluctuates.

“Both systems have to be able to easily communicate with accurate information,” Castro said, noting that the delay conflicted with federal officials saying that there was “no wrong door” to apply for insurance.

Castro added that the problems with the federal marketplace site -- which was largely inoperable in October and November -- are partly due to its complexity. “We know these things can be done -- Amazon does it very well,” Castro said of the online retailer’s ability to handle a large amount of complex data.

The new FamilyCare site should make it easier for residents to apply, Castro said, adding that the state plans to expand the system for other human services programs, such as food stamps.

“When this system actually works, it’s going to be an amazing system,” Castro said.